[Therapeutic strategy for marginally resectable esophageal cancer]

A marginally resectable tumor is defined as a tumor for which the combined resection of surrounding organs is recommended. Esophageal cancer often invades key organs, such as the trachea, bronchus, and aorta, and the preservation of laryngeal function is an important issue when there are tumors located at the cervical esophagus. For marginally resectable tumors of the esophagus, a multimodality treatment should be recommended, because a single-modality treatment cannot cure such advanced diseases. The concept of the treatment strategy is R0 resection after obtaining the down-staging by neoadjuvant treatment. To date, chemoradiation therapy or the combination of chemotherapy and radiotherapy, followed by surgery has been the most promising therapeutic strategies for marginally resectable esophageal cancer. However, there are concerns that must be addressed: the efficacy of 5-FU and cisplatin-based chemotherapy for obtaining control of the disease locally, and the risks and benefits of salvage surgery after chemoradiation therapy. To overcome these problems and to improve the prognosis of patients with marginally resectable tumor of the esophagus, it is necessary to develop new strategies with new regimens of chemotherapy, such as the combined use of docetaxel with 5-FU and cisplatin, to achieve more powerful local control and use of induction chemotherapy, and to validate the safety and efficacy of the salvage surgery.